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Each week, Health Affairs' Rob Lott brings you in-depth conversations with leading researchers and influencers shaping the big ideas in health policy and the health care industry.
A Health Podyssey goes beyond the pages of the health policy journal Health Affairs to tell stories behind the research and share policy implications. Learn how academics and economists frame their research questions and journey to the intersection of health, health care, and policy. Health policy nerds rejoice! This podcast is for you.
Hello, and welcome to Behind the Pages podcast where we will be diving into the May health affairs theme issue on climate, health, and equity. I'm Meg Winchester, senior editor at Health Affairs. And today, I'm joined by Sacoby Wilson from the University of Maryland, where he's director of the health environmental and economic justice lab and professor of global environmental occupational health and one of the advisers for this theme issue. Welcome, Sacoby.
Sacoby Wilson:Yep. Thank you. Excited to be here.
Margaret Winchester:To start, I'm gonna give a little bit of background about the issue and our process, and then we'll dig in. So first, thank you to our funders for the issue, the Kresge Foundation, Robert Wood Johnson Foundation, and thank you to Sacoby and our other theme issue advisors, Cecilia Sorensen from Columbia University. The process of creating a theme issue takes about a year. Last summer, we held a planning meeting with experts in the field. We developed a list of priorities and put out a call for abstracts.
Margaret Winchester:The submitted abstracts went through a few rounds of voting from editors and issue advisors. We invited authors to submit the full papers in November. We also issued a call for nontraditional journal content through our community voices initiative, where we highlight people with lived experiences doing work on the ground. All of the pieces go through editorial and peer review. The issue will be released today, May 4 at 4PM.
Margaret Winchester:We'll also have a free virtual public briefing with the authors on May 6. The link for that is in the show notes, and we hope you can join us. I thought we could pull out a few of the big themes that cut across the papers in this issue to share with listeners. Sacoby, I heard you speak at a conference a few weeks ago when talking about your own journey in doing environmental justice work, and you said, communities know best. And that made me think about the ways that ideas highlighted in this issue.
Margaret Winchester:Can you talk about some of the lessons from and for communities that you see in these papers?
Sacoby Wilson:Yeah. What was really, interesting and I think inspiring for me just to see in general how communities are stepping up and stepping in when it comes to disaster, you know, response, recovery, and really how they've been resilient, right, in response, to these events. Whether it be, you know, forest fires, whether it be floods, whether it be hurricanes, heat waves. So there there are several, manga sources that were published that really elevate, you know, communities who are, you know, building their own systems and really leveraging that contextual knowledge and experiences with disasters. And again, communities, you know, know best.
Sacoby Wilson:Folks on the ground know best because they've experienced disasters. They have the trust in those communities. They have the knowledge systems at the local level to really understand what the issues are and what the right solutions are when it comes to, addressing climate change, but also been, you know, resilient to climate change, been responsive when you have these events. So there was one article that was published, really this climate dashboard in California that looked at issues of how climate change is disproportionately impacting Latin, Latino populations. And what's very interesting about it is that they engaged the community to come up with this dashboard, to come up with the right indicators in the dashboard.
Sacoby Wilson:Then then after the dashboard was developed, it's like, well, we have this visualization of understanding how climate change is differentially impacting Latino populations, but what can we do more with it? So then they really use the information in the dashboard to come up with priorities around how they really, address climate change at the local levels. That's that's that's one example of this kind of co developed dashboard, but was really driven by community priorities. And it and it brings in kinda community gate science, community science, implementation science. And you saw all of that in this paper.
Sacoby Wilson:There's another, example of work around extreme heat in Seattle and just understanding, the issues of how extreme heat can impact, certain populations. And again, how do you engage those groups that are experiencing that live in urban heat islands, that are experiencing, you know, heat waves, that are dealing with heat stress, you know, heat morbidity, heat mortality. And so again, what came out of that were solutions from those populations, from those residents, from those nonprofit groups, from those organizations that are at the front line of protecting folks and dealing with the urban heat on the issue, but protecting people from extreme heat. And there was another, paper where they talked about building hubs, right? Resilience hubs in The Gulf Coast.
Sacoby Wilson:And so you had, you know, different models of resilience hubs where you had a more clinical clinicians working together to think about, you know, how you support, those groups who are experiencing disasters. You had a more government focused hub. Right? We had a more community based hub. And each one was really looking at, you know, different ways of integrating resiliency.
Sacoby Wilson:But really what was inspiring is how, like, this hub model could be a model that's scalable, that we can replicate across the country, across the disaster scenarios, whether it be, you know, post tornado events during, they were not just looking at, you know, response, but also preparedness. Right? So hubs been looking at preparedness, response, recovery, adaptation, mitigation. So whether it be heat issues, heat waves, whether it be hurricanes, whether it be floods, whether it be forest fires, whether it be tornadoes, whether it be extreme cold events, Hubs are a really great model that we learned, in this this manuscript, talked about some of the best practices when it comes to the implementation of hub, these resilience hubs.
Margaret Winchester:I wanna add that the paper you're talking about extreme heat in King County, Washington by Hasan et al has a really cool interactive graphic that goes along with the paper that shows the concept mapping they did with communities. And you can go through and highlight the different pathways that people thought about for responses to extreme heat in their communities and kind of all the different angles that they can take, and it it's fun to play with. And I would also add that we have community voices content that speaks to some of these issues about communities, including a poem, two commentaries, and personal narrative matters essay, and two interviews that highlight the work from perspectives of people addressing climate issues in their local area doing really cool work. So I was also struck in some of the papers by how cross cutting some of these recommendations are. It seems like activities to mitigate climate change effects have wide ranging impacts for vulnerable populations and social drivers of health more broadly.
Margaret Winchester:Can you think of any examples of this?
Sacoby Wilson:Yeah. There was an article, I think the Patel article, talked about COVID related illness and and really, you know, what we need to do to bring in more equity into that. So we talk a lot about, you know, I think in many cases, think about extreme temperatures in the science, in our science communication, the media. A lot of times we we focus, extreme heat. But extreme cold and cold related illness is a big deal.
Sacoby Wilson:And so that article, they talked about issues around extreme cold and the differential impacts of extreme cold and cold related illnesses on the poor, you know, on marginalized populations, on homeless. And it really speaks to when you think about our climate action plans, how do you integrate that focus on code and code related illnesses into your action plan? How are you making sure that you're being responsive to those who may be uninsured and uninsured, responsive to those who may be living below the federal poverty line, be responsive to those folks who may, be unhoused, right, and may have intermittent housing. And so I think that's an important element of equity. And so we think about, you know, cross cutting things around vulnerability.
Sacoby Wilson:You know, we talk a lot about social vulnerability. We talk a lot about, you know, economic vulnerability, geographic vulnerability. But the vulnerability that you experience when you are, unhoused, you are homeless. And and I think that article elevated that really well. And the need to understand the impacts of extreme temperatures, whether it be extreme heat in one regard, but also extreme cold.
Sacoby Wilson:Heat related illnesses on one hand, and also co related illnesses on the other hand when it comes to our most vulnerable populations, including, our unhoused or folks who experience intimate housing.
Margaret Winchester:Yeah. I really like their stratified analysis Yeah. So we can dig down on different populations. Can you think of any other examples?
Sacoby Wilson:Yeah. It was another article that really dug into, you know, equity issues around health care. I believe it's the Weed et al article. So how, know, evidence based interventions to decarbonize care, improve climate resilience. So I thought it was very interesting how they talked about, like, more meso level interventions, macro level interventions when you think about, health care.
Sacoby Wilson:So green accounting, you know, they talk about policies about, you know, climate education and climate resilience. And there's this really different ways that around health and healthcare that we can do more to understand, you know, the impacts of climate change, but what are those interventions? And also how can healthcare could be like an anchor kind of a node, a central infrastructure? So when you're trying to activate it, to be part of the ecosystem of care when it comes to climate change, whether it be, response, recovery, and resilience. So I think that paper really provides a blueprint for some of the different interventions and strategies that we can take, if you're in the healthcare space, to make, know, as the, to reduce like the impact of your footprint, but as an infrastructure, what we can do to elevate that as an infrastructure, you know, in the work that we do around making our communities more climate resilient.
Sacoby Wilson:So healthcare infrastructure is an important part of our overall climate resilient infrastructure.
Margaret Winchester:Yeah. Absolutely. I I think those are some great examples. I wanted to touch on your last point about the health system as a good place to start in addressing climate change. And I think this is something that's of interest to our regular health affairs readers.
Margaret Winchester:And my biggest takeaway from these papers is that we have solutions. We have known solutions, and the focus should be not on creating new things from scratch, but ex expanding and preserving existing policies that work and then scaling them.
Sacoby Wilson:Exactly. I mean, health health systems, I mean, I talk a lot about from a you know, in talking about equity and justice perspective, you know, we have some systems that are not been really responsive to the needs of communities when it when it comes to addressing issues of environment, whether it be environmental justice or or climate change. But but was just stated, we do see in health systems, we see a lot of innovation because they have patient populations are vulnerable. Right? So we can look to a lot of these leading health entities who are doing this great work around making their facilities more climate resilient, you know, decarbonizing, reducing their carbon footprint, but also a lot of the climate education work, we can partner with them.
Sacoby Wilson:So I think one key that comes from this special issue is the power of partnerships. How do we build across sectors? How do we build across, you know, sort of build bridges? But we do that through partnerships. So more, multi sectoral partnerships with health systems, with health care as one of those core partners is important is what I also got in this special issue.
Margaret Winchester:Yeah. I love that. We have an overview paper by Carlos Gould and coauthors that talks about some of these specific existing channels and policy, and they highlight things like Medicaid section eleven fifteen waivers, in lieu of services provisions, MA supplemental benefits. These are mechanisms we have that address social determinants of health and they can be channeled to deal with climate change in an upstream way, that we're not just responding to crises after they happen, but we can build in resilient policies on a larger scale. And the wheat paper that you mentioned earlier, I really like the policy levers they talk about, which include circular economy practices to reduce medical waste.
Margaret Winchester:So we have less single use things going into landfills, and they advocate mandating carbon accounting. So we we have lots of tools out there.
Sacoby Wilson:Yeah. And so and so if you see if and then it's also just the it's the leadership. Right? So if you see these tools have been implemented in in the health care space, right, in that sector, then hospitals are following other hospitals. Right?
Sacoby Wilson:You're sharing these best practices. You're seeing reduced costs. You're seeing reduced impacts. Right? You're seeing more lives saved, but then also entities in other sectors, other industries can also kind of see that work in the healthcare sector as a model.
Sacoby Wilson:So that's think it's also a a value of the the work, the leadership, that we're seeing and the innovation that we're seeing in the healthcare sector when it comes to climate change, when it comes to climate resilience.
Margaret Winchester:I love that. Yeah. We have a few papers that look more in the labor sector and look at these impacts on workers, but there's spillover for their health and the health care system. And so, yeah, it's all overlapping. But one of the things that can happen reading these papers and thinking about climate and environmental justice work is it can feel a little bit doom and gloom.
Margaret Winchester:You know, this this can look pretty grim that we have all of these very clear effects of climate change on human health. It's very expensive. There are systems that are really struggling. We're we're figuring out how to respond to these increasing crises. So I was wondering in your own work, what gives you hope?
Margaret Winchester:What keeps you hopeful?
Sacoby Wilson:No. That's a that's a great question. I mean, no, as someone, you know, I I'm in I'm in a verbal health scientist. I mean, I do a lot of, you know, environmental justice scholarship research and advocacy. Right?
Sacoby Wilson:And, you know, in this social movement, I think it's important that hope is an important part of the work. Right? Being optimistic, being joyful, you know, thinking about the small wins, the small victories. It can be very difficult, for many of the you know, for me, just not difficult for me personally, but in the in the work that I do in engaged communities that are impacted by informal justice issues, these there these communities will also have differential economic risks. Right?
Sacoby Wilson:And so you have these compounding vulnerabilities, these compounding risks that people are experiencing. Then you have some communities that are experiencing like, know, climate displacement after hurricanes, you have climate justification. There's a lot of stuff that happens. Right? But I think what gives me hope is like the article, the highlights on communities that have the knowledge, that have the experience, they have the tools, They have the skills.
Sacoby Wilson:They are resilient. Right? And I think we think about climate resilience, we also have to move beyond resilience. Like they are not just surviving, in the words of one of my colleagues, doctor Masaf Ali, they're also thriving. Right?
Sacoby Wilson:So how can we make sure in these moments and as we move forward with, you know, addressing climate change and helping communities, you know, with adaptation and mitigation, that we focus on on the solutions. Right? As I like to say, many of our newspapers do a great job of talking about doom and gloom. The world's gonna end. That's not a way to build a movement.
Sacoby Wilson:That's not a way to engage people. Right? So you engage people with a with a framework of hope. You engage people with a with solutions. You engage people like, hey, look what's happening in Seattle.
Sacoby Wilson:Look what they've done. You know, look what's happening in California, working with regional populations around this dashboard. Look what's happening in the Gulf Coast, how these hubs are working. They did it out of survival, now you have these community driven processes to really combat climate change. We should be uplifting those things, uplifting these case studies, these best practices, and those stories of folks who are overcoming the crisis of climate change.
Sacoby Wilson:Right? Who are every year, there is a heat wave, there's a fire but they're still here. They're still here. And they're still what's the right way to say it? They are still moving forward with their lives.
Sacoby Wilson:They're still moving forward with their families. So I say what what, you know, keeps me hopeful is the fact that communities are still here. They are not just surviving mode, they are thriving even in light of these constant, climate crises that they're experiencing. And I also, you know, wanna say what gives me hope is, you know, like in this moment with a lot of turmoil in the country and the world, you know, neighbors are helping neighbors when it comes to, you know, these events. We see it all the time when you see a flood on TV, you see how neighbors come together.
Sacoby Wilson:When you see a heat event, you know, so you watch the news, neighbors come together. Hurricane, pre hurricane, post hurricane, neighbors come together, even strangers. So people's humanity, right, shows up when we have these these clown events. And I think that gives me hope for as a you know, our humanity shines through, at the local level. You've seen that, you know, being translated to policy.
Sacoby Wilson:You've seen it being translated across sectors. You've seen it being translated in in in for our kids. Right? Kids are dealing with climate anxiety. And so how we are helping our youth who are dealing with these these climate issues and how the inspiration from them and how they're also stepping up and stepping in.
Sacoby Wilson:So I think it's a I think a lot of things give me hope for the future, like the near future and for, you know, 2050 with all of our climate goals. Right? So, yeah, it's just it's just really good to be part of this larger movement to combat climate change, to combat environmental injustices, which are connected, and also to combat some of the public health inequities people are experiencing, which are also connected. So the fact that people are looking at these issues more intersectionally, they're looking at it across, sectors, and they're working together on the ground and letting those folks the folks who are most impacted are leading the way, that gives me a lot of hope.
Margaret Winchester:I love that. Thank you. Yeah. I think there are some implicit narratives of hope in this work that we're seeing in this issue. Also, I conducted one of the interviews with our community voices content with Amanda Lee who works for Eco America, and she talks about getting people to talk about climate change with their neighbors, that she's the young person doing this work, but sparking conversation, and their climate ambassador program is really kind of generating momentum.
Margaret Winchester:So I think that's worth checking out.
Sacoby Wilson:And then and after that, I mean, the the fact that folks, I mean, as you said earlier, we're talking about this. I mean, we think about how do you combat climate change? You can combat climate change by combating the social determinants of health. Right? How do you make people more resilient?
Sacoby Wilson:Right? And move for survival and thriving. So if you have if you move from unjust housing and just housing, that that housing is gonna be more resilient when you have a climate event. You move from unjust transportation to justification, that's gonna be more resilient when you have a climate event. You move from unjust food system to just food systems, that food system is gonna be more resilient when you have a climate event.
Sacoby Wilson:So I think that understanding, right, of why justice is important and making sure that these efforts are community led, community driven, I think that that gives me again hope And to that story that you talked about with with the folks for Eco America, like neighbors just breaking climate change down and just making it real for people, like connected to food, faith, family health, and jobs, Those are social terms of health. So just wanted to say that.
Margaret Winchester:Yeah. I mean, we've got a lot of work to do, but there's a lot of good things happening. So I think that's all we have time for today. Thank you all for tuning into Behind the Pages. I hope you check out the May issue.
Margaret Winchester:It's available open access on our website healthaffairs.org today, May 4. And please join us for the briefing on Wednesday, May 6 to go even more into depth on these topics. Thanks for being here, Sacoby.
Sacoby Wilson:Yeah. Thank you.